Elsevier

Clinical Psychology Review

Volume 24, Issue 8, December 2004, Pages 1011-1030
Clinical Psychology Review

A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder

https://doi.org/10.1016/j.cpr.2004.08.004Get rights and content

Abstract

A number of qualitative and meta-analytic reviews point to the efficacy of psychotherapeutic and pharmacological interventions for obsessive-compulsive disorder (OCD). In this article, we report a multidimensional meta-analysis of psychological and pharmacological treatment studies for OCD published between 1980 and 2001, examining a range of variables not previously meta-analyzed, including exclusion rates and exclusion criteria, percent of patients improved or recovered post-treatment, mean post-treatment symptomatology, and long-term outcome. These additional metrics provide a more nuanced view of the strengths and limitations of the existing data and their implications for clinical practice. Behavioral and cognitive-behavioral therapy, and a range of pharmacological interventions, lead to substantial improvement for the average patient, with individual psychotherapies and clomipramine and other Serotonin reuptake inhibitors faring best across multiple metrics. However, OCD symptoms persist at moderate levels even following adequate treatment course, and no replicable data are available on maintenance of gains for either form of treatment at 1 year or beyond. Future research should track recruitment and exclusion of study participants, include more comorbid patients, and focus on longer-term follow-up using multiple indices of outcome. More research on combined pharmacological and psychotherapeutic interventions is also indicated.

Section snippets

Multidimensional meta-analysis

A multidimensional meta-analysis presents a range of statistics bearing on clinical utility and external validity, which can be important in assessing the strengths and limitations of treatments of psychiatric disorders, whether psychotherapeutic or pharmacologic (or both). One important variable pertains to the process by which patients are selected and screened. Studies that screen out a high proportion of subjects or that implement stringent exclusion criteria before patients are even

Selection of studies

We used a two-phase search process to identify randomized controlled trials (RCTs) of psychotherapy for OCD published between January 1980 and December 2001: (1) a search of PsycINFO and Medline, using the keywords “obsessive-compulsive” and “OCD”; and (2) a manual review of prior meta-analyses and reviews for studies not obtained using the first procedure. To be included, a study had to test the efficacy of a specific psychotherapy against a control condition, an alternative psychotherapy, a

Selection of studies

To maximize the likelihood of obtaining all relevant published research reports, we used a three-phase search process. First, we performed an issue-by-issue search of 22 high quality, high-impact journals that routinely publish efficacy research, including research on OCD (e.g., American Journal of Psychiatry, Archives of General Psychiatry). Next, we conducted an exhaustive computer search of PsycINFO and Medline using the keywords “obsessive compulsive.” Last, we manually reviewed prior

Discussion

The data reported here replicate findings reported in other meta-analyses and reviews regarding the efficacy of psychotherapy for OCD and extend them in a number of ways. Consistent with prior meta-analyses, both psychotherapy and pharmacotherapy produce substantial decreases in OCD symptoms, reflected in (a) pre-treatment vs. post-treatment effect sizes; (b) a substantial percentage of patients who improve with treatment and (c) considerable declines in symptoms from pre- to post-treatment.

Acknowledgement

Preparation of this manuscript was supported in part by NIMH grants MH62377 and MH62378 to the fourth author.

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